Provider Demographics
NPI:1417356155
Name:BARYSENKA, ALENA
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:BARYSENKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 E 19TH ST APT A12
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3319
Mailing Address - Country:US
Mailing Address - Phone:818-288-3134
Mailing Address - Fax:
Practice Address - Street 1:1379 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3340
Practice Address - Country:US
Practice Address - Phone:908-687-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02583100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist